HomeMy WebLinkAboutFESLER LT 1AMark Begich
Mayor
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Elmore Rood
P.O. Box 196650
Anchorage, AK 99507
www.muni.orq/onsite
(907) 343-7904
Well Drilling Permit Number: SW,
Pump Installation Log
Parcel Identification Number:
Date of Issue:
Legal Description ?Msp 3ET AT:
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Property Owner Name & Address:
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Pump Installation Date: '7 _8_55"
Pump Intake Depth Below Top of Well Casing: Y6 feet
Pump Manufacturer's Name: R e ;) 7ACk C
Pump Model: 6c' ss' --
Pump Size 1 J;: --hp
Pitless Adapter Burial Depth: 1 0 feet
Pitiess Adapter Manufacturer's Name:
Pitless _Adapter Installer: I ,
Well Disinfected Upon Completion'? i'? L—ji No
Method of Disinfection: c14Lcse%nit_ PES WTS
Comments:
Pump Installer Name: A t, v e5
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.